Neutrophil-to-Lymphocyte Ratio and Its Relation with Markers of Inflammation and Myocardial Necrosis in Patients with Acute Myocardial Infarction and Chronic Coronary Syndrome

Background: Inflammation has an essential role in atherosclerosis that is the leading reason for acute coronary syndrome (ACS) which includes acute myocardial infarction (AMI) and unstable angina (UA). The objective of this work was to study the existence of difference in Neutrophil to Lymphocyte ratio and its relation to inflammatory markers between cases with AMI and cases with chronic coronary syndrome. Methods: This work included sixty consecutive cases with AMI and ACS who presented to cardiovascular medicine department at Tanta university hospital. The cases were classified into two equal groups; group I: cases with AMI and group II: cases with chronic coronary syndrome. All participants were subjected to ECG, Echocardiography, color Doppler, coronary angiography and laboratory investigations as differential CBC, cardiac enzymes, troponine, CK, CK-MB, CRP, urea, creatinine and random blood sugar. Patients who didn’t meet the criteria for invasive treatment, continued on medication and further noninvasive investigations done, starting from stress ECG, stress echocardiography, or CCTA. Results: There were insignificantly different between the two groups regarding age, gender and residency (p= 1.00). There was insignificant difference between the two groups regarding hypertension (p= 0.592), DM (p= 0.795) and dyslipidemia (p= 0.504). 7 (23.3%) cases were smokers in group I and 8(26.7%) patients were smokers in group II with insignificantly different between the two groups (p= 1.00). Conclusions: NLR is a powerful marker of myocardial damage in acute myocardial cases.

Effect of Mild Hypothermia on Morbidity and Mortality in Post AMI Cardiogenic Shock

Background: Acute myocardial infarction (AMI) complicated with cardiogenic shock is still associated with a significant death rate. Other interventions, including intra-aortic balloon counter pulsation and medical therapy, failed to improve prognosis in large-scale randomised studies, with the exception of early revascularization. Recently, mild therapeutic hypothermia, in which patients are lowered to 33°C over the course of 24 hours, has been proposed as a therapy option for cardiogenic shock patients. The purpose of this study is to determine the impact of mild hypothermia on morbidity and mortality associated with post-AMI cardiogenic shock. Methods: This randomized, controlled, unblinded trial was conducted on 50 patients with AMI complicated by CS. Patients were randomly allocated into two equal groups; group I received MTH to 33°C for 24-36 h and group II (control group) did not receive MTH. Patients were subjected to full history taking, general and clinical examination, laboratory examination, echo, chest ultrasound (US), coronary angiography data and mild therapeutic hypothermia protocol. Results: Stroke until day 30, duration of mechanical ventilation, length of ICU stay, duration of inotropic support, mortality and pulmonary congestion by US were insignificantly different between both groups. Arterial lactate and mean arterial blood pressure (MAP) at 4h, 6h, 8h, 10h, 12h, 14h, 16h, 18h, 20h were significantly increased in group I than Group II (P value<0.05). and were insignificantly different between both groups at 0h, 2h, 22h, 24h, 26h, 28h, 30h. Serum creatinine at 24h, 48h was significantly increased in group I than Group II (p value <0.05) and was insignificantly different between both groups at 0h. Conclusions: Therapeutic hypothermia (TH) didn’t improve short term outcomes in patients with post AMI cardiogenic shock.

Risk Factors and In-hospital Outcome of Young Adults Presented with Acute Myocardial Infarction and Treated with Primary PCI

Background: Acute myocardial infarction (AMI) is often characterised pathologically as the death of cardiomyocytes as a consequence of persistent ischaemia result in an acute imbalance among oxygen supply and demand. Coronary artery disease (CAD) is the leading cause of death worldwide. AMI mainly affects patients older than 40 years of age, however, young can suffer MI. In the developing countries, CAD is becoming an epidemic, where it occurs in younger persons at greater rates. Clinical features and prognosis of young patients tend to vary from those of older individuals. the outcomes of a MI may be especially severe at a young age because of its larger potential influence on the patient's psyche, capacity to work, and socioeconomic burden. AMI is less prevalent in young people than in older persons, since only 2 to 6 % of the younger population suffers from the condition. Primary PCI is the optimal therapy for STEMI if it can be done promptly, preferably within 90-120 minutes of provider contact. Methods: The present research performed on 60 subjects who had AMI and treated with primary PCI. The cases were allocated into 2 groups, group 1 involved young subjects aged 40 years old or less (30 patients) and group 2 involved older patients aged more than 40 years (30 patients). All patients underwent complete history taking, cardiological clinical examination, investigations, coronary angiography and PCI. Results: Concerning age there was statistically significant difference among two groups while there was no significant difference regarding to sex. regarding risk factors there was significant difference among both groups regarding to hypertension, DM, previous MI, cerebrovascular disease and drug abuse. Regarding to laboratory investigation, there was no significant difference regarding CK, CKMB, creatinine and random blood sugar. There was no significant difference regarding to culprit artery and TIMI flow after PCI while there was statistically significant difference regarding number of vessels involved. Regarding to outcome there was no significant variation among the two groups regarding to acute HF, cardiogenic shock, re-infarction, and death. As regarding to bleeding, it was significant higher in group II. Conclusions: Prevalence of Acute ST Elevation Myocardial Infarction “STEMI” in young people is increasing due to sedentary and stressful lifestyle and bad habits as smoking and addiction. The most widespread and important risk factors in these patients are smoking, addiction, mental stress and hyperlipidemia with less prevalence of hypertension and diabetes mellitus. Young patients present most commonly with anterior then inferior STEMI.

In Hospital Mortality in Patients with Impaired Fasting Glucose and Acute Myocardial Infarction in a Tertiary Care Centre of Rural Bengal

Introduction : The Cardiovascular mortality in Diabetics is 2-4 times higher than in Non-diabetic population. But there is still controversy regarding Pre-diabetes (IFG and IGT) as a Cardiovascular Risk Factor. Aims and Objectives : In this study we aimed to investigate the early in-hospital mortality among Acute Myocardial Infarction (AMI) patients having Impaired Fasting Glucose (IFG) during the first 7 days of hospitalization. Materials and Methods: A total of 150 AMI patients were evaluated and followed up for their glycemic status and early in hospital mortality (first 7 days) at Burdwan Medical College, Burdwan, West Bengal. Result and Analysis: Mortality in patients having IFG (18%) was higher and as much as in DM (20%) compared to euglycemic (4%) patients but the mortality is not correlated with mean Fasting Plasma Glucose (FPG) level. Conclusion : IFG (ie, pre-diabetes) increases Cardiovascular mortality as much as diabetes. So, IFG may be a marker or risk factor for mortality but lowering FPG in AMI patients is unlikely to yield beneficial effect regarding mortality.

Factores asociados a esteatosis hepática no alcohólica en pacientes del área rural del cantón Chambo / Factors Associated with Nonalcoholic Hepatic Steatosis in Patients from the Rural Area of Chambo town

La hepatopatía crónica más prevalente en el mundo es la esteatosis hepática no alcohólica. Así, se realizó una investigación con el objetivo de determinar los factores asociados a esa patología en pacientes atendidos en el Centro de salud tipo B Chambo, Ecuador, durante 2020. Se realizó un estudio con enfoque cuantitativo, de tipo no experimental, correlacional y retrospectivo. Las historias clínicas seleccionadas aportaron los datos de las variables de interés. La media de la edad de los involucrados fue de 54,43 ± 8,10 años. El 60,38% tenía hipertensión arterial, el 52,83% diabetes mellitus, el 62,26% sobrepeso u obesidad y el 49,06% dislipidemia, determi-nando que estas comorbilidades tuvieron una relación significativa con la enfermedad objeto de estudio, la que resultó más incidente en edades mayores de 50 años. Las personas sedentarias o con bajos niveles de actividad física mostraron de ALT y AST.

The most prevalent chronic liver disease in the world is nonalcoholic fatty liver disease. Thus, research aimed to determine the factors associated with this pathology in patients treated at the Type B Chambo Health Center, Ecuador, during 2020. A study was carried out with a quantitati-ve, non-experimental, correlational, and retrospective approach. The selected medical records provided the information for the variables of interest. The mean age of the population was 54.43 ± 8.10 years of age. 60.38% had arterial hypertension, 52.83% diabetes mellitus, 62.26% overweight or obesity and 49.06% dyslipidemia. It was determined that these comorbidities had a significant relationship with the disease under study, which was more incident in ages older than 50. Sedentary people or those ones with low levels of physical activity showed ALT and AST.

Lo mejor de ACC 2021

Entre el 15 y el 17 del pasado mes de mayo de 2021 se llevó a cabo un nuevo congreso virtual del American College of Cardiology, uno de los eventos científicos más esperados de la cardiología mundial. Se contó con expositores de excelente nivel y la presentación de trabajos destacados que han realizado un aporte significativo a nuestra práctica clínica referidos a un gran abanico de situaciones frecuentes: cirugía cardíaca, cardiología intervencionista, manejo de arritmias. A continuación, seleccionamos y resumimos algunos de los trabajos más significativos: Aspirin versus clopidogrel for chronic maintenance monotherapy after percutaneous coronary intervention (HOST-EXAM). TicAgrelor versus CLOpidogrel in Stabilized Patients with Acute Myocardial Infarction (TALOS-AMI). Left Atrial Appendage Occlusion during Cardiac Surgery to Prevent Stroke III (LAAOS III). Sotagliflozin in Patients with Diabetes and Recent Worsening Heart Failure (SOLOIST-WHF). A Randomized Ablation-based atrial Fibrillation rhythm control versus rate control Trial in patients with heart failure and high burden Atrial Fibrillation (RAFT-AF). Aspirin Dosing: A Patient-Centric Trial Assessing Benefits and Long-Term Effectiveness (ADAPTABLE).

Summary: The Annual meeting of the American Cardiology College Congress was held virtually between 15th and 17th of May in present 2021. This is indeed one of the most expected and relevant scientific events in the world of Cardiology. We had excellent speakers and outstanding presentations updating central themes in our clinical practice referring to a wide range of frequent situations such us: cardiac surgery, interventional cardiology, management of arrhythmias. Bellow, we select and summarize some of the most significant works: Aspirin versus clopidogrel for chronic maintenance monotherapy after percutaneous coronary intervention (HOST-EXAM). TicAgrelor versus CLOpidogrel in Stabilized Patients with Acute Myocardial Infarction (TALOS-AMI). Left Atrial Appendage Occlusion during Cardiac Surgery to Prevent Stroke III (LAAOS III). Sotagliflozin in Patients with Diabetes and Recent Worsening Heart Failure (SOLOIST-WHF). A Randomized Ablation-based atrial Fibrillation rhythm control versus rate control Trial in patients with heart failure and high burden Atrial Fibrillation (RAFT-AF). Aspirin Dosing: A Patient-Centric Trial Assessing Benefits and Long-Term Effectiveness (ADAPTABLE).

De 15 a 17 de maio de 2021, foi realizada uma nova reunião virtual do congresso anual do American College of Cardiology, um dos eventos científicos mais relevantes do mundo da cardiologia. Houve excelentes palestrantes e a apresentação de estudos notáveis ​​que atualizaram temas centrais em nossa prática clínica referentes a uma ampla gama de situações comuns: cirurgia cardíaca, cardiologia intervencionista, manejo de arritmias. A seguir, selecionamos e resumimos algumas das obras mais significativas: Aspirina versus clopidogrel para monoterapia de manutenção crônica após intervenção coronária percutânea (EXAME-HOST). TicAgrelor versus CLOpidogrel em pacientes estabilizados com infarto agudo do miocárdio (TALOS-AMI). Oclusão do apêndice atrial esquerdo durante a cirurgia cardíaca para prevenir acidente vascular cerebral III (LAAOS III). Sotagliflozina em pacientes com diabetes e insuficiência cardíaca recente (SOLOIST-WHF). Um ensaio randomizado de controle de ritmo de fibrilação atrial baseado em ablação versus controle de frequência em pacientes com insuficiência cardíaca e fibrilação atrial de alta carga (RAFT-AF). Dosagem de aspirina: um estudo centrado no paciente que avalia os benefícios e eficácia a longo prazo (ADAPTÁVEL).

Collaterals Doctrine Guided Investigation into Traditional Chinese Medicine Pathogenesis and Clinical Treatment of Myocardial Fibrosis Following Acute Myocardial Infarction / 中国实验方剂学杂志

Interventional or thrombolytic therapy for acute myocardial infarction （AMI） has the effect of opening occluded coronary arteries. However， due to no myocardial regurgitation， ischemia/reperfusion injury and microvascular structure and function destruction， leading to myocardial fibrosis following AMI， ventricular remodeling， and even cardiac failure may occur. Collaterals doctrine is used to guide the investigation into traditional Chinese medicine pathogenesis and clinical treatment of myocardial fibrosis following AMI. Consequently， it proposes the pathogenesis characteristic of "Qi deficiency and blood stasis， collaterals obstruction" and medication principle of "dispersing and dredging"， to develop the formula of Tongxinluo. Fundamental and clinical researches have demonstrated it can effectively protect the structure and function of myocardial microvascular endothelial cells， improve no reflow and reperfusion injury， and inhibit myocardial fibrosis after AMI， which further supports scientific value of the collaterals doctrine.

Multi-disciplinary team on acute heart failure complicated with respiratory failure after allograft nephrectomy / 器官移植

Objective To evaluate the effect of multi-disciplinary team (MDT) on acute heart failure (AHF) complicated with respiratory failure after allograft nephrectomy. Methods MDT discussion was performed on a patient with hemorrhagic shock caused by sudden renal graft hemorrhage, who developed acute myocardial infarction (AMI) with AHF, acute pulmonary congestion, pulmonary infection and acute respiratory failure 2 weeks after allograft nephrectomy. And treatment plan was formulated and effect evaluation was conducted. Results Based on the opinions of MDT discussion, the patient was given nasal high-flow oxygen therapy, continuous veno-venous hemodiafiltration (CVVHDF) to reduce cardiac load, anticoagulant, dilating blood vessels, reducing myocardial oxygen consumption, improving myocardial remodeling, lipid regulation, anti-infection, nutritional support, and other comprehensive treatment. The clinical outcome of the patient was good and regular hemodialysis treatment was resumed. Conclusions Application of MDT pattern helps to formulate a comprehensive and effective individualized treatment plan for patients with AHF and respiratory failure after allograft nephrectomy, which can enhance clinical treatment effects and improve prognosis of patient.

The influence of the gut microbiota on the bioavailability of oral drugs

Due to its safety, convenience, low cost and good compliance, oral administration attracts lots of attention. However, the efficacy of many oral drugs is limited to their unsatisfactory bioavailability in the gastrointestinal tract. One of the critical and most overlooked factors is the symbiotic gut microbiota that can modulate the bioavailability of oral drugs by participating in the biotransformation of oral drugs, influencing the drug transport process and altering some gastrointestinal properties. In this review, we summarized the existing research investigating the possible relationship between the gut microbiota and the bioavailability of oral drugs, which may provide great ideas and useful instructions for the design of novel drug delivery systems or the achievement of personalized medicine.

Study of Microalbuminuria in Non-Diabetic and Non-Hypertensive Patients with Acute Myocardial Infarction

Introduction: Microalbuminuria has relationship on thedevelopment of coronary heart disease and it may identify asa new risk factor of this disease. The MA happens more oftenin diabetic patients with AMI but it has been reported evenin non –diabetic patients with AMI. The aim of the presentstudy was to assess the prevalence of microalbuminuria innon diabetic and non hypertensive patients suffering fromAMI. To evaluate the relationship between MA and AMI innon- diabetic and non hypertensive patients admitted in ICCUcardiology department at Rajshree Medical Research InstituteBareilly (UP).Matereial and methods: The study was carried out in thedepartment of Biochemistry and ICCU in RMRI, Bareilly(UP) to establish the correlation between MA with 50non diabetic, non hypertensive patients of AMI and in50 healthy age matched controls. MA was determined byimmunoturbidimetric method and plasma glucose weremeasured by enzymatic method.Result: There was a significant increase in the level of MA inpatients with AMI who were non diabetic, non hypertensive ascompare to those in the healthy control.Conclusion: MA may have an association with AMI inabsence of traditional risk factors like diabetes and HTN. SoMA can be used as an adjunct biochemical parameter in nondiabetic, non hypertensive AMI patients.

Meta-Analysis for Effect of Danhong Injection on Cardiac Function and TIMI During Perioperative PCI in Acute Myocardial Infarction / 中国实验方剂学杂志

<b>Objective::Evaluate the effects of Danhong injection for perioperative percutaneous coronary intervention (PCI) on cardiac function and thrombolysis in myocardial infarction (TIMI) in patients with acute myocardial infarction (AMI). <b>Method::Computer retrieving CNKI, Wanfang database, VIP database, PubMed, CBM, Web of Science, The Cochrane Library, gathering Danhong injection in percutaneous coronary intervention perioperative application in the treatment of acute myocardial infarction clinic trials. The Cochrane risk evaluation is adopted to improve the quality of literature evaluation, with Revman 5.3 software for Meta-analysis. <b>Result::Participants included in 12 clinic trials contains a total of 1 131 patients, including 569 patients in Danhong treatment and 562 patients in control group. The results showed that compared with conventional treatment, Danhong injection treated patients had LVEF increased obviously [mean difference (MD)=6.62, 95% confidence interval (CI) (4.91, 8.34), <italic>P</italic><0.000 01], the number of TIMI class 3 patients significantly increased[relative risk (RR)=0.22, 95%CI(0.12, 0.41), <italic>P</italic><0.000 01], and BNP levels significantly decreased [MD=151.86, 95%CI (-247.00, -56.72), <italic>P</italic>=0.002]. <b>Conclusion::Danhong injection can improve the function of acute myocardial infarction after percutaneous coronary intervention.

Early diagnosis and prognostic evaluation value of miR-133a in patients with acute myocardial infarction / 上海交通大学学报（医学版）

Objective: To investigate the value of serum miR-133a in early diagnosis and the assessment of 30-day incidence of cardiovascular adverse events in patients with acute myocardial infarction (AMI). Methods: Ninety patients with acute chest pain within 6 h were included, and 63 cases of AMI, 13 cases of unstable angina pectoris (UAP) and 14 cases of control (chest pain of other causes) were finally diagnosed. The levels of troponin I (cTnI), creatine kinase MB (CK-MB) and myoglobin (Mb) were measured by electrochemical fluorescence. Quantitative real-time PCR (qPCR) was used to detect the expression of miR-133a in the serum of patients immediately after admission and 24 h after percutaneous coronary intervention (PCI). The Gensini score of patients who underwent coronary angiography was recorded. The incidence of cardiovascular adverse events was observed within 30 days. Spearman correlation analysis, multivariate Logistic regression analysis and receiver operator characteristic curve (ROC curve) were used to analyze the corresponding data. Results: The expression of miR-133a in the AMI group was significantly higher than that in the UAP group and the control group (both P<0.05). Spearman correlation analysis showed that the expression of miR-133a was positively correlated with cTnI, CK-MB, MB level and Gensini scores (all P<0.05). Multivariate Logistic regression analysis showed that miR-133a and the history of coronary heart disease were independent risk factors for AMI. ROC curve showed that the area under the curve (AUC) of miR-133a in the diagnosis of AMI was 0.816 (95% CI 0.716-0.917), and the AUC of 30 days cardiovascular adverse event was 0.700 (95% CI 0.535-0.865). Conclusion: The expression of miR-133a in patients with AMI is significantly increased, which is expected to be a biomarker for early diagnosis of AMI. The expression level of miR-133a in serum may be related to the severity of coronary artery disease and short-term prognosis.

The Study of Mortality in Hospitalized Patients with Impaired Fasting Glucose in Acute Myocardial Infarction

Introduction: Hypertension is one of most commoncardiovascular disorder in clinical practice. It is also calledhigh blood pressure. Hypertension is well known risk factorfor cardiovascular, renal and cerebrovascular disease. Evenslightly rise elevated blood pressure lead to increase risk incardiovascular disease and strokes (CVD). Hypertensiveemergency is define as recent increase in blood pressure toa very high level (> 180 mmHg systolic and > 110 mmHgdiastolic) with target organ damage. Study aimed to evaluatethe modes of presentations, clinical profile and spectrum oftarget organ damage in patients with hypertensive emergency.Material and methods: This study was hospital basedprospective study. The present study was carried out in 100patients admitted in various medical wards in R.N.T. MedicalCollege Udaipur, Rajasthan over a period of eight months.Patients fulfilling the eligible criteria were included.Result: Among the 100 patients studied, 70 were males andthe male female ratio was 2.33:1. In the age distribution, 72%patients were found age more than 50 years and rest 28% wasless than 50 years. The commonest clinical presentation foundwas neurological deficits in 50% followed by dyspnoea in34% and chest pain in 10% patients.Conclusion: The present study done over hypertensiveemergencies patients conclude that majority of patientsbelonged to the fifth and sixth decades of age and of malesex. It was commonly observed in the patients knownhypertensive. Diabetes and dyslipidemias was commonassociation observed. Commonest mode of presentation wasneuro deficit and higher level of mean blood pressure at thetime of presentation may associated with worst out come

Study of in-hospital outcome in acute myocardial infarction in correlation with thrombolysis in myocardial infarction risk score

Background: The Thrombolysis in Myocardial Infarction (TIMI) risk score is purportedly an integral score for mortality risk prediction in fibrinolysis-eligible patients with STEMI. Attempt was made to evaluate the same by correlating risk stratification by TIMI score with hospital outcome of such patients.Methods: There were 145 cases of STEMI were studied and TIMI risk scores were calculated and analysed vis-à-vis various relevant parameters. The patients were divided into three risk groups: ‘low-risk’, ‘moderate-risk’ and ‘high-risk’ based on their TIMI scores. All patients received routine anti-ischemic therapy and were thrombolysed subsequently, monitored in ICCU and followed during hospital stay for occurrence of post-MI complications.Results: There were 79 patients (54.5%) belonged to low-risk group, 48 (33.1%) to moderate-risk group and 18 (12.4%) to high-risk group according to TIMI risk score. The mortality (total 17 deaths) was observed to be highest in the high-risk group (55.6%), followed by moderate-risk (12.2%) and low-risk group (1.28%) respectively. Out of the 7 potentially suspect variables studied, Killips classification grade 2-4 had the highest relative risk (RR-15.85), followed by systolic BP <100mmHg (RR- 10.48), diabetes mellitus (RR- 2.79) and age >65 years (RR- 2.59).Conclusions: The TIMI risk scoring system seems to be one simple, valid and practical bed side tool in quantitative risk stratification and short-term prognosis prediction in patients with STEMI.

Coronary computed tomography angiography in patients with myocardial infarction and non-obstructed coronary arteries

Background: Cardiovascular disease (CVD) is the number one cause of death worldwide. In India almost 30,000 people suffer an acute myocardial infarction (AMI) each year and, despite the greatly improved survival after AMI, CVD remains the leading cause of death among women and men. During the last decade, there has been increasing awareness of the significant minority of patients with acute myocardial infarction, for whom invasive coronary angiography (ICA) does not show any coronary artery stenoses. This condition is called myocardial infarction and non-obstructed coronary arteries (MINOCA) and is still incompletely understood. Aim of the study: To investigate whether patients with MINOCA had a greater coronary plaque burden determined by coronary CTA than a control group matched by age and gender. Materials and methods: Totally 100 patients were included in the study Patients presenting to the department of cardiology, SRM Medical College Hospital and Research Institute Kattangulathur, Kanchipuram District, Chennai with an ACS between January 2018 to May 2019. In the first step, patients with MINOCA were screened for the SMINC study Patients were eligible to take part in the study if they were between 35 and 70 years old, fulfilled the criteria for acute myocardial infarction (AMI) according to the universal definition of AMI and underwent ICA showing no or minimal signs Venkatesh Munusamy, Veeraraghavan Sriram, Dhandapani Vellala Elumalai. Coronary computed tomography angiography in patients with myocardial infarction and non-obstructed coronary arteries. IAIM, 2019; 6(8): 18-25. Page 19 of atherosclerosis (defined as the presence of plaque discernible on ICA, but no stenosis exceeding 30% by visual estimation). All patients also underwent cardiovascular magnetic resonance (CMR) imaging at a median of 12 days after hospital admission. Results: MINOCA patients did not have more CAD than healthy controls, matched by age and gender. A large proportion of MINOCA patients had no signs of CAD at coronary CTA. Conclusion: Thus, MINOCA should not be considered a definitive diagnosis, but rather a working diagnosis, warranting additional diagnostic evaluation. Myocarditis is one of the conditions that may manifest itself as MINOCA. Findings of the SMINC study, where myocarditis was excluded by CMR, suggest that TS is an important cause of MINOCA. Other potential causes include CAD with rupture of a non-stenotic lesion, coronary artery spasm, thrombotic disorders, and microvascular dysfunction.

Hyperthyroidism presenting as ST elevation myocardial infarction - a case report / Journal of the ASEAN Federation of Endocrine Societies

@#<p style="text-align: justify;">A 31-year-old male, apparently well, presented with typical chest pain. His ECG showed ST-elevation from V1-V4 and echocardiogram revealed anteroseptal wall hypokinesia with an ejection fraction of 45%. Normal coronary arteries were seen on coronary angiogram. A thyroid function test showed elevated free T4 levels with suppressed thyroid stimulating hormone (TSH). Treatment with thionamides and beta-blockers improved symptoms. Upon review 4 months later he was well. Repeat echocardiogram showed good ejection fraction with no hypokinetic area.</p>

Combining fragmented QRS and TIMI score for predicting in-hospital short-term prognosis after acute myocardial infarction / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Acute myocardial infarction (AMI) has a high mortality rate and poor prognosis for patients. The primary causes of death are arrhythmia and heart failure. For patients admitted because of myocardial infarction, various risk evaluations are initiated to foresee possible complications. The thrombolysis in myocardial infarction (TIMI) risk score, which can be used to predict the prognosis and the need for revascularisation, is the most convenient and commonly used system, but is inadequate for AMI patients on admittance. Fragmented QRS (fQRS) has been shown to be a valuable electrocardiographic (ECG) index for predicting the prognosis of patients with coronary heart disease. Also, fQRS is considered to predict an increased likelihood of a poor outcome and mortality in patients with coronary artery disease (CAD), even for some successfully revascularized AMI patients. So what would happen if fQRS and the TIMI risk score were combined? This study focused on the investigation of the short-term prognostic value of fQRS combined with the TIMI risk score for patients with AMI.

Effects of ginkgolide B on the ventricular wall motion of patients with acute myocardial infarction after revascularization / 中成药

AIM To investigate the role of ginkgolide B on the ventricular wall motion and systolic function in acute myocardial infarction (AMI) patients after their revascularization.METHODS A total of 80 cases of AMI patients who underwent revascularization were divided into control group and ginkgolide B treatment group,with 40 patients per group.The two groups of patients both treated basically with routine western medicine were dosed with either placebo or ginkgolide B for 3 months.The cardiac function,normal myocardial percentages,ventricular wall motion,longitudinal peak systolic strain (LPSS) and rate (LPSSR) were evaluated by dobutamine stress echocardiography and these indexes were compared.RESULTS Compared to the control group,left ventricular ejection fraction (LVEF) (66.06 ± 8.39 vs.60.45 ± 13.35,P ＜0.05) and normal myocardial percentages (86.88 ±8.76 vs.79.84 ± 12.25,P ＜0.01) were significantly improved at the 2nd week in ginkgolide B treatment group,but no significant difference on ventricular wall motion was observed'between the two groups (P ＞ 0.05).For the patients with anterior wall AMI,the minus LPSS and LPSSR at basal,middle and apex segment were significantly improved at the 2nd week in ginkgolide B treatment group compared to the control group (P ＜ 0.05,P ＜ 0.01).Moreover,LPSS at apex segment was significantly improved at the 3rd month in ginkgolide B treatment group compared to the control group (P ＜ 0.05).For the patients with inferior wall AMI,minus LPSS at basal and apex segment were significantly improved at the 2nd week and the 3rd month in ginkgolide B treatment group compared to the control group (P ＜ 0.05),whereas minus LPSSR at basal and middle segment at the 2 nd week and basal segment at the 3rd month were significantly improved in ginkgolide B treatment group compared to the control group (P ＜0.05).CONCLUSION Revascularized AMI patients treated with ginkgolide B can expect an improved ventricular wall motion.

Effect of dexmedetomidine pretreatment on contents of glutamic acid and γ-aminobutyric acid dur-ing focal cerebral ischemia-reperfusion in rats / 中华麻醉学杂志

Objective To evaluate the effect of dexmedetomidine pretreatment on contents of glu-tamic acid and γ-aminobutyric acid during focal cerebral ischemia-reperfusion ( I∕R) in rats. Methods Thirty-six clean-grade healthy male Wistar rats, aged 10 months, weighing 250-300 g, were divided into 3 groups using a random number table method: sham operation group (group S), I∕R group, and dexme-detomidine group (group D). Focal cerebral I∕R was induced by occlusion of the left middle cerebral artery for 30 min followed by reperfusion in anesthetized rats. The left middle cerebral artery was only isolated but not occluded in group S. Sterile normal saline 1 ml was intraperitoneally injected, and 30 min later the model of focal cerebral I∕R was established in group I∕R. Rats were sacrificed at the end of reperfusion, and brains were removed for determination of contents of glutamic acid and γ-aminobutyric acid in brain tis-sues and for examination of ultrastructure (with an electron microscope). Results Compared with group S, the content of glutamic acid was significantly increased, and the content of γ-aminobutyric acid was de-creased in I∕R and D groups (P＜0. 05). Compared with group I∕R, the content of glutamic acid was signif-icantly decreased, and the content of γ-aminobutyric acid was increased in group D (P＜0. 05). The dam-age to the ultrastructure of brain tissues was significantly attenuated in group D when compared with group I∕R. Conclusion Dexmedetomidine pretreatment can reduce focal cerebral I∕R injury through decreasing the content of glutamic acid and increasing the content of γ-aminobutyric acid in rats.

TWO YEARS SURVIVAL IN PATIENTS WITH STEMI TREATED PRIMARY PCI / Шинэ санаа Шинэ нээлт

@#BACKGROUND: Acute myocardial infarction is leading cause of global morbidity and mortality and major health care burden in worldwide. Previous studies demonstrated that restoration of myocardial tissue perfusion after primary PCI is significant factor of improved outcome. In Mongolia, studying long term effects of primary PCI in patients with AMI and its’ association with coronary blood flow, tissue Doppler imaging, left ventricular global strain pattern in speckle-tracking echocardiography and risk factors are essential in theoretical and clinical practice. AIMS: To determine long term effects of primary PCI in patients with AMI and its’ association with left ventricular strain pattern in speckle-tracking echocardiography, risk factors and patient prognosis. METHODS: We used prospective cohort study design. We were selected 414 patients with AMI who treated by primary PCI between 2015 and 2016 at the State Third Central Hospital. Echocardiographic examination was conducted on Philips iE33 xMATRIX ultrasound machine. The PCI was performed according to the MNS:6379-2013 standard. RESULTS: Mean age was 60±13 and majority of them were male 84% (n=347). Complete coronary perfusion (TIMI-3) was achieved in patients 88% (n=367) after primary PCI. There was weak, negative correlation between coronary TIMI flow grade and left ventricular global longitudinal strain (r=-0.183, CI 95% -0.289 to-0.066, p<0.001). In patients with incomplete coronary perfusion (TIMI<3), mortality rate was significantly higher during 24 months follow-up. After primary PCI, 24 months mortality was 9.9% (n=39). Cut-off value of left ventricular global longitudinal strain which predict long term (within 24 month follow-up) mortality was -12.93% (sensitivity 74.4%, specificity 74.3%). Mortality during 24 months follow-up was significantly different between left ventricular global longitudinal strain groups (log-rank test p<0.001) and mortality was higher in left ventricular global longitudinal strain ≥ -12.93% group. CONCLUSION: Coronary no-reflow phenomenon is associated with long term mortality in patients with AMI. In patients with AMI who treated by PCI, long term mortality is predictable with left ventricular global longitudinal (≥-12.93%, p<0.001) strain.